SUBSTANCE ABUSE

Conditions resulting from different patterns of drug use including acute sedative overdose, acute stimulant
intoxication, harmful or hazardous drug use, cannabis dependence, opioid dependence, stimulant dependence,
benzodiazepine dependence and their corresponding withdrawal states.

  • Harmful or hazardous use: causing damage to health (physical, mental or social functioning)
  • Dependence: situation in which drug use takes on a much higher priority for a given individual than other behaviours that once had greater value.

Causes

  • Social factors: peer pressure, idleness/unemployment, social pressures, poverty, cultural use, increased
    availability
  • Psychological factors: other psychiatric disorders e.g. anxiety, depression, stress, adolescent development
    changes

Commonly abused drugs

  • Tobacco (cigarettes, shisha, kuber, mirage, migagi)
  • Cannabis (njaga, bhangi, marijuana)
  • Khat (mairungi)
  • Heroin (brown sugar)
  • Cocaine
  • Petrol fumes and organic solvents (e.g. thinners)
  • Opioids: pethidine, morphine
  • Amphetamines (e.g. speed)
  • Mandrax® (methaqualone)
  • Benzodiazepines
  • Barbiturates (phenabarbitone)

Clinical features

Presenting features that may point to drug use disorders

  • Change in behaviour e.g. excessive irritability
  • Change in function e.g. decline in school/work performance
  • Loss of interest
  • Episodes of intoxication e.g. slurred speech, staggering gait
  • Involvement in illegal activities e.g. rape, theft
  • Change in appearance e.g. weight loss, red eyes, puffy face, untidy, scars from multiple needle pricks
  • Financial difficulties e.g. stealing, unpaid debts
  • Relationship problems e.g. increased conflicts, communication breakdown
  • Find out if person uses illegal or prescribed drugs in a way that risks damage to their health

Investigations

  • Ask about use of illicit or non-prescribed drugs

If yes, assess for features of dependence (3 or more of the following):

  • A strong desire to take drugs
  • Difficulties controlling drug use in terms of onset, termination or levels of use
  • A physiological withdrawal state when drug use has ceased or been reduced (as shown by classic withdrawal
    symptoms)
  • Evidence of tolerance: increased doses of the drug are required to achieve effects originally produced by lower
    doses
  • Progressive neglect of alternative pleasures or interests because of drug use
  • Drug use persists despite clear evidence of harmful consequences e.g. depression, loss of a job
    • Investigate concurrent physical or mental illnesses

Management

  • Assess for and manage co-existing medical conditions e.g. HIV
  • Treat presenting symptoms (acute intoxication or withdrawal)
  • Assess for harmful use (substance abuse but not meeting criteria for dependence) or dependence
  • Psychoeducation and counselling
  • Refer to self help groups if possible
  • Refer to specialist for further management (detoxification and substitution therapy)

Prevention

  • Health education on dangers of drug use
  • Employment/recreational opportunities
  • Encourage social and cultural values
  • Attempt to reduce availability of drugs of abuse in communities